Goebell P J, Otto T, Rübben H
Klinik und Poliklinik für Urologie, Kinderurologie und Urologische Onkologie, und Westdeutsches Tumorzentrum Essen, Medizinische Einrichtungen der Universität, Gesamthochschule Essen, Germany.
Onkologie. 2003 Aug;26(4):361-5. doi: 10.1159/000072097.
Despite local tumor control, patients with locally advanced bladder cancer or lymphogenic metastasized urothelial carcinoma are at risk for systemic progress. Radical cystectomy is the gold standard treatment for muscle-invasive bladder tumors. Pelvic lymphadenectomy remains an integral part of the surgical treatment. However, the extent of the lymph node dissection depends on its diagnostic or curative intent and is more controversial. In addition, further treatment options such as systemic chemotherapy or combined radio-chemotherapy are needed to improve the outcome of locally advanced or metastasized disease. Therefore, administration of additional therapy to surgical treatment is intensively studied. The application of the neoadjuvant concept as well as the definite role of the adjuvant chemotherapy currently are contentious topics and subjects of meta-analyses and prospective randomized trials. In addition, bladder preservation as part of a multimodality treatment is still discussed as an option for selected patients unsuitable for radical cystectomy. This article gives an overview on the current concepts of the use of neoadjuvant systemic chemotherapy in the treatment of advanced urothelial cancer.
尽管实现了局部肿瘤控制，但局部晚期膀胱癌或淋巴源性转移尿路上皮癌患者仍有发生全身进展的风险。根治性膀胱切除术是肌肉浸润性膀胱肿瘤的金标准治疗方法。盆腔淋巴结清扫术仍然是手术治疗的一个组成部分。然而，淋巴结清扫的范围取决于其诊断或治疗意图，且更具争议性。此外，需要进一步的治疗选择，如全身化疗或联合放化疗，以改善局部晚期或转移性疾病的治疗效果。因此，对手术治疗联合额外治疗的应用进行了深入研究。新辅助治疗概念的应用以及辅助化疗的确切作用目前是有争议的话题，也是荟萃分析和前瞻性随机试验的主题。此外，作为多模式治疗一部分的膀胱保留术，对于那些不适合根治性膀胱切除术的特定患者，仍是一种可供讨论的选择。本文概述了新辅助全身化疗在晚期尿路上皮癌治疗中的当前应用概念。
